Effects of exercise and stress management training on nighttime blood pressure dipping in patients with coronary heart disease: A randomized, controlled trial

Abstract

INTRODUCTION Blunted nighttime blood pressure (BP) dipping is prognostic of cardiovascular morbidity and mortality. Patients with coronary heart disease (CHD) are often characterized by a blunted nighttime BP dipping pattern. The present study compared the effects of two behavioral intervention programs, aerobic exercise (EX) and stress management (SM) training, with a usual care (UC) control group on BP dipping in a sample of CHD patients. METHODS This was a secondary analysis of a randomized controlled trial with allocation concealment and blinded outcome assessment in 134 patients with stable CHD and exercise-induced myocardial ischemia. Nighttime BP dipping was assessed by 24-hour ambulatory blood pressure monitoring (ABPM), at pre-randomization baseline and following 16 weeks of one of the following treatments: usual medical care; usual care plus supervised aerobic exercise for 35 min 3 times per week; usual care plus weekly 1.5 hr sessions of stress management training. RESULTS The EX and SM groups exhibited greater improvements in SBP dipping (P = .052) and DBP dipping (P = .031) compared with UC. Post intervention SBP percent-dipping means were 12.9 (SE = 1.5) for SM, 11.1 (SE = 1.4) for EX, and 8.6 (SE = 1.4) for UC. Post intervention DBP percent-dipping means were 13.3 (SE = 1.9) for SM, 14.1 (SE = 1.8) for EX, and 8.8 (1.8) for UC. CONCLUSIONS For patients with stable CHD, exercise or stress management training resulted in improved nighttime BP dipping compared to usual medical care. These favorable effects of healthy lifestyle modifications may help reduce the risk of adverse clinical events.

The Impact of Blood Pressure Dipping Status on Cognition, Mobility, and Cardiovascular Health in Older Adults Following an Exercise Program

“…Finally, with regard to changes in the magnitude of BP dipping in nondippers, we observed these individuals increased BP dipping after the intervention. This finding aligns with previous studies and demonstrates that exercise may improve BP dipping profile, even when daytime and nighttime systolic BP remain unchanged ( Ling et al, 2014 ; Sherwood, Smith, Hinderliter, Georgiades, & Blumenthal, 2016 ).…”

Heme Oxygenase-1 Activity as a Correlate to Exercise-Mediated Amelioration of Cognitive Decline and Neuropathological Alterations in an Aging Rat Model of Dementia

“…It has long been known that physical exercise confers many beneficial effects on health. Studies demonstrate that exercise improves cardiovascular function [ 56 ], cognitive ability [ 27 ], and insulin resistance and symptoms of metabolic syndrome [ 57 ] and decreases the severity of neuropsychiatric problems, including depression [ 58 ]. Di Loreto et al demonstrated that regular physical activity potently augmented neuroprotective functions as a correlate of age-related amyloidogenesis and additionally preserved synaptic function [ 59 ].…”

Aerobic exercise training improves nocturnal blood pressure dipping in medicated hypertensive individuals

“…Exercise training could reduce two of the key features of elevated nighttime BP, which are sympathetic nervous system and RAAS over activity [9]. However, the information on the effects of aerobic exercise training on nocturnal BP dipping in hypertensive population is meager and contradictory, with studies finding a dipping effect [10,11], whereas others failed to find an effect [12,13].…”

“…Similarly, Sherwood et al . [11] found in coronary heart disease patients that aerobic exercise training improved nighttime BP dipping compared with usual medical care. However, Nami et al .…”